Collecting 80% of patient balances instead of chasing them

Everything, all day, by herself

Between 100 and 140 patients come through Quaker Ridge Foot Care each week, and every one of them comes through Reina: she checks them in, verifies their insurance, answers the phones, preps the rooms between appointments, handles billing, and more.

The phone rings while she’s checking someone in. The next patient walks in while she’s on the phone. There’s no gap in a day like that, which is why the administrative work doesn’t happen during the week. It happens on Friday, the one day she keeps clear for the paperwork the other four generate.

Quaker Ridge has been open since 1989, and Reina has been there for 32 of those years. In that time, most of the independent podiatrists around them have been absorbed into hospital systems and groups.

Quaker Ridge stayed independent with the same two-member staff: just the physician and her. Whatever needs doing gets done by one of them.

Collections were the piece that never fit.

High deductibles and coinsurance, once mostly an out-of-network concern, are now standard in-network, and most patients arrive with no real idea what they will owe.

That left Reina printing statements, mailing them to addresses patients had moved away from without telling her, and working balances that sat open for a year before anyone acknowledged them.

Hiring was not the answer either. She brought on help years ago and ended up doing triple the work correcting their mistakes.

The bottleneck was never effort. It was a collections process that depended on her remembering to chase every open balance while doing seven other jobs.

One workflow instead of three

The copay is the only number Reina can be certain of at the front desk. Whatever the deductible turns out to be shows up weeks later, after the claim comes back and the patient is long gone.

Before card on file: three disconnected steps

Bridge Payments gave her a way to turn an uncertain future balance into a predictable payment process: card on file.

The patient signs a system-generated authorization form, the card is stored securely, and any remaining balance is charged once the claim is processed. What was once a series of disconnected steps became a single workflow.

She had built her own paper version of that bundled workflow before. Bridge Payments was the first time it held together end to end. So saving a card on file became office policy.

With card on file: one connected workflow

New-patient paperwork now states plainly that any patient with a deductible, coinsurance, or outstanding balance leaves a card on file. It is not a judgment call made patient by patient. It is simply how the practice operates, explained the same way to everyone at the front desk.

She kept one rule of her own on top of it. Before any card is charged, the patient gets a call.

If they answer, she tells them the amount. If they don’t, she leaves a message and emails the receipt.

That transparency is what turned an early round of patient pushback into a non-issue, and it means she is no longer waiting on a callback that never comes.

With card on file: “Less headaches. Faster payments.”

Card on file reversed the numbers

The clearest measure of the change is a ratio Reina uses herself. Before card on file, roughly 20% of what patients owed came in on its own and the other 80% had to be pursued.

Those numbers have flipped.

Today, about 80% of patient balances are captured through cards on file the moment the claim comes back, and the 20% that still takes a fight is the exception rather than the routine. She puts the time she has gotten back at close to 90%.

Payment plans changed the same way. A patient who needs to spread a balance picks the charge date, and the system takes it from there.

Friday shows it most clearly. It is still billing day, but the work has changed.

She used to spend it printing statements, following up on balances from weeks earlier, and waiting on callbacks that rarely came. Now she works through what came back from the insurers and closes most of it the same day.

One recent Friday a $218 balance came back. She reviewed it, called the patient, ran the card, and emailed the receipt in a few minutes. That balance would once have become a statement, then a second statement, then a phone call a year later.

What she tells other practice managers

Reina is direct about the objection she hears most often, which is that patients will resist keeping a card on file. Her experience is that resistance came from inconsistency, not from the card itself.

Once card on file became written policy applied to every patient, that resistance largely stopped.

Her second piece of advice is to stop treating statements as the default.

Quaker Ridge collects at the point of service and settles the remainder against the card on file. Patients who specifically want a mailed invoice are told there is an administrative fee for it, and almost no one takes that option.

Paper billing is now the exception the practice has to be asked for, rather than the process it falls back on 140 times a week.

She is candid that the harder sell is usually not the patient. A practice that has run the same way for decades does not change on the first ask, so she raises an idea, and then raises it again, until it lands.

Her own way of putting it: if you water the plant, it will grow.

Several years in, she recommends Bridge Payments to other practices without being asked, and she is still adding to what she uses. Her questions now are about what else to turn on: online payments for younger patients and caregivers, and automatic alerts when a card on file is about to expire.

Asked why she keeps recommending it, she does not need long to answer: “Less headaches. Faster payments.”